Research into teen driving aims to reduce deadly crashes and to increase parental involvement.
It was a fantasy come true for a baseball-loving teenager: In 1961, the L.A. Dodgers asked Bruce Morton to serve as a bat boy. The young man, now known as Dr. Bruce Simons-Morton, worked as a bat boy for three years, long before he made a name for himself in research. He saw Sandy Koufax throw two no-hitters. He marveled as Maury Wills racked up enough stolen bases to set a new Major League record, toppling Ty Cobb's earlier mark.
Aside from witnessing these and other baseball feats, Dr. Simons-Morton learned an important lesson from his years as a bat boy: the art of identifying and taking advantage of opportunities. After earning an MPH from Johns Hopkins and an Ed.D. in health education from the University of Northern Colorado, he served as a professor at the University of Texas Medical Branch and the University of Texas School of Public Health. In 1992, he brought his entrepreneurial spirit to NICHD. He now serves as branch chief and senior investigator for the NICHD's Prevention Research Branch within the Division of Epidemiology, Statistics, and Prevention Research.
At NICHD, he and his colleagues built a robust portfolio of research in a new area for NICHD: teen driving safety. View a slideshow that illustrates NICHD's work on teen driving.
Dr. Simons-Morton first became interested in studying teen driving when his post-doctoral fellow, Dr. Patricia Eitel, proposed that NICHD conduct a study on the topic.
"We started with a survey of teenagers and asked them about their driving privileges and parental supervision of their driving after they got their licenses," said Dr. Simons-Morton. "We were surprised that most kids got their license and their parents gave them the keys with no restrictions at all. So we followed up with a prospective study. We realized that we needed to learn much more about teen driving, so we started developing a more comprehensive program of research."
The former bat boy saw an area of need and opportunity.
"There are a lot of people interested in young drivers, but compared to other adolescent problems it's relatively understudied, and a relatively small number of researchers are studying the problem," said Dr. Simons-Morton. "For example, there are hundreds and hundreds of papers published monthly on adolescent smoking and alcohol consumption...In contrast, only in the past 5 to 10 years has there been systematic research on teenage driving. We are only now beginning to understand the young driver problem."
The "young driver problem"
"Motor vehicle crashes are the leading cause of death and injury for adolescents," said Dr. Simons-Morton. "That makes teen driving a very important area for NICHD to study. Around the country, there are only a few groups that have really studied the issue of teen driving systematically. As an intramural researcher at the NIH, you can garner resources to study in depth a particular topic. That's what we've done with our young driver research."
"Crashes are very high among novice drivers, who improve only with experience," said Dr. Simons-Morton. "How does a teenager get experience without crashing? Why do teenagers have so many crashes? What puts some teens at more risk than others? What can be done to reduce the prevalence of risky driving among teenagers and the time it takes for novices to get better? These questions are the focus of our research: What is the nature of the teen driving problem and how do we prevent teen driving crashes?"
Over the past 10 years, Dr. Simons-Morton has examined many aspects of teenage driving. To examine the nature of teenage driving risk, he and his colleagues conducted the first naturalistic teenage driving study. A naturalistic study examines the people's behavior as they go about their daily activities. The researchers followed 42 teens for 18 months as they drove cars equipped with cameras and accelerometers that measure how quickly an automobile's speed changes.
"Our naturalistic driving research has demonstrated that measures of risky driving are associated with the likelihood of a crash," said Dr. Simons-Morton. "Youth who drive in a more risky fashion measured by hard stops and sharp turns are much more likely to have a crash in the next month than youth who have low rates of these events."
Though the conclusion was not surprising, Simons-Morton said that his study was the first to show that risky driving measured in this objective manner predicted the likelihood of a crash. "Ultimately, I predict that accelerometers will be available on all vehicles and that the data on risky driving will be used to determine crash risk by law enforcement and insurance companies," he said.
In another study, conducted on a test track, Dr. Simons-Morton and colleagues asked novice teen and experienced adult drivers to take a cell phone from a research assistant, dial a number, and retrieve information while driving. The researchers then turned the light the driver was approaching to amber just as the participant began the task. The adult drivers were not very good at the cell phone task, but they always looked up and stopped at the light. Teens were very good with the cell phone, but nearly a third of them failed to look up in time to stop at the red light. Because not looking is a major cause of crashes, the relatively greater distraction among teenagers places them at elevated crash risk.
Another study conducted by Dr. Simons-Morton's research team examined the effect of teenage passengers on teenage risky driving. The researchers observed vehicles exiting high school parking lots and recorded the license numbers and the relative age and sex of the drivers and passengers. On a nearby road, where the vehicles could get up to speed, the researchers assessed speeding and following distance with a radar gun and video camera. Compared to other drivers, teens drove slightly faster and closer to the lead vehicle. However, in the presence of a male teen passenger, both male and female teenage drivers drove even faster and with less distance between cars. Male drivers with male passengers were by far the worst. The researchers concluded that the presence of male teenage passengers increased risky driving among both male and female teenage drivers.
In addition to examining teen driving risk, Dr. Simons-Morton and colleagues have studied the prevention of crashes. Since 1990, all 50 states have adopted graduated driver's licensing (GDL) requirements in various forms. Through GDLs, young drivers who have recently received their drivers' licenses are limited in the time of day and the number of passengers they may drive. As the young drivers get older and gain experience, the restrictions are eased.
"GDLs are a very thoughtful and effective policy intervention," said Dr. Simons-Morton. "GDL is really designed to increase the amount of supervised practice driving before people get licensed and then set limits on driving during the provisional licensing stage."
Though the rate of teen driving fatalities has decreased since the popularization of GDL requirements, automobile accidents are still the leading cause of death for this age group. GDL requirements, says Dr. Simons-Morton, are great, but not enough. He calls GDLs a "passive approach" to teen driving safety, because police enforcement occurs only in the case of another violation, such as a teen being caught speeding when driving after midnight. For that reason, parental involvement in teen driving is just as important as GDLs.
"GDL sets only modest limits, and it falls to parents to enforce the restrictions on graduated driver licensing and establish even stricter limits," he said. Thus, Simons-Morton is focusing much of his research on new ways to involve parents with their teenagers' driving.
Two promising approaches
Through a series of randomized trials, Dr. Simons-Morton and his team developed and evaluated the Checkpoints Program, which is designed to facilitate parents setting strict limits and then granting additional driving privileges as their teens demonstrate responsible driving behavior.
The program is beginning to catch on: Michigan and Maryland have adopted versions of the program, and a website, http://www.saferdrivingforteens.org, is available to the general public. Dr. Simons-Morton says he hopes the program will be more widely adopted. "We have had lots of interest from drivers' education teachers, state departments of motor vehicles, parent-teacher groups, and other interest groups."
Dr. Simons-Morton recently studied a technology, the DriveCam, which was first used to monitor commercial driving and is now available to parents who want to monitor their teenagers' driving. The DriveCam, uses an accelerometer linked to a camera to detect and record risky driving incidents such as rapid stops and quick turns, also known as elevated G-force events.
Dr. Simons-Morton recently concluded a study, not yet published, of the DriveCam. The device was placed in the cars driven by 90 teenagers. After a two-week period with no feedback from the device, all of the teens began to receive immediate feedback on their driving: A red light blinked whenever a driver exceeded the G-force threshold. Half of the teens knew that their parents would not receive feedback from the DriveCam; the other half knew that their parents would be able to access DriveCam video footage and data.
The researchers found that the teens whose parents did not receive DriveCam data did not improve their driving at all. In other words, getting immediate feedback about their driving was not enough. Only the teens whose parents could access DriveCam video footage improved their driving. The frequency of G-force events dropped significantly among this group.
"We learned that teens are more likely to change their driving behavior when they know there will be consequences for risky driving," Dr. Simons-Morton said.
The DriveCam costs approximately $900 to install and use for one year. The manufacturer recently started a partnership with the American General Insurance Company to offer a large discount to families who install DriveCams.
"Insurance companies say that they lose money on young drivers because young drivers crash at fairly high rates—about one crash at least every two years on average,." said Dr. Simons-Morton. "So it's very expensive for insurance companies to insure teens. Anything they can do to reduce teen crashes, they will."
Parents often gain a fresh perspective from their spouses and their children, and Dr. Simons-Morton and his wife, Dr. Denise Simons-Morton, are no exception. Dr. Denise Simons-Morton is the director of the Division for the Application of Research Discoveries (DARD) at the National Heart, Lung, and Blood Institute (NHLBI). The couple have two children, a son and daughter who are both in their 20s.
"We both try out ideas on each other all the time. Denise is one of the smartest people I know, and I often seek her counsel. She's trained in medicine and epidemiology and has been a clinical trialist for many years. She's also a very good editor. She often reads and comments on my papers. Our shared training in public health has been a very rich and important part of our relationship.
"When my kids were younger, I was focused on children's diet and physical activity," said Dr. Bruce Simons-Morton. "As they got a little older, my focus switched to adolescent substance abuse. Before they were teenagers, I started doing the research on teen drivers. I'm not sure if this was entirely intentional, but I've been studying topics that are just a little ahead of their developmental stage. Of course, everybody learns from their children. You learn how your kids work and how their friends work. That allows you to develop hypotheses that you can study later."
"My colleagues and I were constantly experimenting and finding out what our children would eat, how to introduce food to them, and how to encourage physical activity. It was very unscientific, but to an extent I experimented with my children. They probably have completed 1,000 questionnaires.
"I think by the time they were ready to drive, they were so used to being in a house where we were interested in research and public health that they took to the parental driving agreement without complaint."
"No service too small"
After all these years, Dr. Simons-Morton still loves baseball. In fact, he was looking forward to attending a Nationals game with his son. And he fondly recalls his days as a bat boy for the L.A. Dodgers.
In addition to taking care of the players' bats, the young Dr. Simons-Morton had other duties. "There were a lot of things we did off the field for the players. We laundered their uniforms. I used to clean and shine as many as fifty pairs of shoes and cleats every evening after the ball game. We put out food and beverages for the players. I even delivered notes from the ballplayers to spectators in the stands. There was no service too small. We were running a little business.
"There was a former minor leaguer who was the clubhouse manager. He probably got a salary, but pretty much he ran this clubhouse on the tips from the players. At the end of a [series of home games], the clubhouse manager and the bat boys would line up, and the players would walk by and give us a fistful of coins or dollars."
The more valuable the bat boys had been to the players, the better their tips. "What I learned [as a bat boy] was to be entrepreneurial," he said. That lesson learned as a young man served Dr. Simons-Morton well. When the former college baseball player didn't realize his dream of making the Major Leagues, he sought other opportunities. As he said with a smile, "It was a good thing there was graduate school."